Development and validation of an ankle brachial index risk model for the prediction of cardiovascular events

F.G.R. Fowkes, G.D. Murray, I. Butcher, A.R. Folsom, A.T. Hirsch, D.J. Couper, G. DeBacker, M. Kornitzer, A.B. Newman, K.C. Sutton-Tyrrell, M. Cushman, A.J. Lee, J.F. Price, R.B. D'Agostino Sr, J.M. Murabito, P.E. Norman, K.H. Masaki, L.M. Bouter, R.J. Heine, C.D.A. StehouwerM.M. McDermott, H.E.J.H. Stoffers, J.A. Knottnerus, M. Ogren, B. Hedblad, W. Koenig, C. Meisinger, J.A. Cauley, O.H. Franco, M.G.M. Hunink, A. Hofman, J.C. Witteman, M.H. Criqui, R.D. Langer, W.R. Hiatt, R.F. Hamman, the Ankle Brachial Index Collaboration

Research output: Contribution to journalArticleAcademicpeer-review

22 Citations (Scopus)

Abstract

The ankle brachial index (ABI) is related to risk of cardiovascular events independent of the Framingham risk score (FRS). The aim of this study was to develop and evaluate a risk model for cardiovascular events incorporating the ABI and FRS.An analysis of participant data from 18 cohorts in which 24,375 men and 20,377 women free of coronary heart disease had ABI measured and were followed up for events.Subjects were divided into a development and internal validation dataset and an external validation dataset. Two models, comprising FRS and FRS?+?ABI, were fitted for the primary outcome of major coronary events.In predicting events in the external validation dataset, C-index for the FRS was 0.672 (95% CI 0.599 to 0.737) in men and 0.578 (95% CI 0.492 to 0.661) in women. The FRS?+?ABI led to a small increase in C-index in men to 0.685 (95% CI 0.612 to 0.749) and large increase in women to 0.690 (95% CI 0.605 to 0.764) with net reclassification improvement (NRI) of 4.3% (95% CI 0.0 to 7.6%, p?=?0.050) and 9.6% (95% CI 6.1 to 16.4%, p?p?modest.
Original languageEnglish
Pages (from-to)310-320
Number of pages11
JournalEuropean Journal of Preventive Cardiology
Volume21
Issue number3
DOIs
Publication statusPublished - Mar 2014

Keywords

  • PERIPHERAL ARTERIAL-DISEASE
  • CORONARY-HEART-DISEASE
  • LOWER-EXTREMITY
  • FOLLOW-UP
  • TASK-FORCE
  • PRACTICE GUIDELINES
  • PRESSURE INDEX
  • OLDER-ADULTS
  • PRIMARY-CARE
  • ALL-CAUSE

Cite this

Fowkes, F. G. R., Murray, G. D., Butcher, I., Folsom, A. R., Hirsch, A. T., Couper, D. J., ... Ankle Brachial Index Collaboration, T. (2014). Development and validation of an ankle brachial index risk model for the prediction of cardiovascular events. European Journal of Preventive Cardiology, 21(3), 310-320. https://doi.org/10.1177/2047487313516564
Fowkes, F.G.R. ; Murray, G.D. ; Butcher, I. ; Folsom, A.R. ; Hirsch, A.T. ; Couper, D.J. ; DeBacker, G. ; Kornitzer, M. ; Newman, A.B. ; Sutton-Tyrrell, K.C. ; Cushman, M. ; Lee, A.J. ; Price, J.F. ; D'Agostino Sr, R.B. ; Murabito, J.M. ; Norman, P.E. ; Masaki, K.H. ; Bouter, L.M. ; Heine, R.J. ; Stehouwer, C.D.A. ; McDermott, M.M. ; Stoffers, H.E.J.H. ; Knottnerus, J.A. ; Ogren, M. ; Hedblad, B. ; Koenig, W. ; Meisinger, C. ; Cauley, J.A. ; Franco, O.H. ; Hunink, M.G.M. ; Hofman, A. ; Witteman, J.C. ; Criqui, M.H. ; Langer, R.D. ; Hiatt, W.R. ; Hamman, R.F. ; Ankle Brachial Index Collaboration, the. / Development and validation of an ankle brachial index risk model for the prediction of cardiovascular events. In: European Journal of Preventive Cardiology. 2014 ; Vol. 21, No. 3. pp. 310-320.
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abstract = "The ankle brachial index (ABI) is related to risk of cardiovascular events independent of the Framingham risk score (FRS). The aim of this study was to develop and evaluate a risk model for cardiovascular events incorporating the ABI and FRS.An analysis of participant data from 18 cohorts in which 24,375 men and 20,377 women free of coronary heart disease had ABI measured and were followed up for events.Subjects were divided into a development and internal validation dataset and an external validation dataset. Two models, comprising FRS and FRS?+?ABI, were fitted for the primary outcome of major coronary events.In predicting events in the external validation dataset, C-index for the FRS was 0.672 (95{\%} CI 0.599 to 0.737) in men and 0.578 (95{\%} CI 0.492 to 0.661) in women. The FRS?+?ABI led to a small increase in C-index in men to 0.685 (95{\%} CI 0.612 to 0.749) and large increase in women to 0.690 (95{\%} CI 0.605 to 0.764) with net reclassification improvement (NRI) of 4.3{\%} (95{\%} CI 0.0 to 7.6{\%}, p?=?0.050) and 9.6{\%} (95{\%} CI 6.1 to 16.4{\%}, p?<?0.001), respectively. Restricting the FRS?+?ABI model to those with FRS intermediate 10-year risk of 10 to 19{\%} resulted in higher NRI of 15.9{\%} (95{\%} CI 6.1 to 20.6{\%}, p?<?0.001) in men and 23.3{\%} (95{\%} CI 13.8 to 62.5{\%}, p?=?0.002) in women. However, incorporating ABI in an improved newly fitted risk factor model had a nonsignificant effect: NRI 2.0{\%} (95{\%} CI 2.3 to 4.2{\%}, p?=?0.567) in men and 1.1{\%} (95{\%} CI 1.9 to 4.0{\%}, p?=?0.483) in women.An ABI risk model may improve prediction especially in individuals at intermediate risk and when performance of the base risk factor model is modest.",
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author = "F.G.R. Fowkes and G.D. Murray and I. Butcher and A.R. Folsom and A.T. Hirsch and D.J. Couper and G. DeBacker and M. Kornitzer and A.B. Newman and K.C. Sutton-Tyrrell and M. Cushman and A.J. Lee and J.F. Price and {D'Agostino Sr}, R.B. and J.M. Murabito and P.E. Norman and K.H. Masaki and L.M. Bouter and R.J. Heine and C.D.A. Stehouwer and M.M. McDermott and H.E.J.H. Stoffers and J.A. Knottnerus and M. Ogren and B. Hedblad and W. Koenig and C. Meisinger and J.A. Cauley and O.H. Franco and M.G.M. Hunink and A. Hofman and J.C. Witteman and M.H. Criqui and R.D. Langer and W.R. Hiatt and R.F. Hamman and {Ankle Brachial Index Collaboration}, the",
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Fowkes, FGR, Murray, GD, Butcher, I, Folsom, AR, Hirsch, AT, Couper, DJ, DeBacker, G, Kornitzer, M, Newman, AB, Sutton-Tyrrell, KC, Cushman, M, Lee, AJ, Price, JF, D'Agostino Sr, RB, Murabito, JM, Norman, PE, Masaki, KH, Bouter, LM, Heine, RJ, Stehouwer, CDA, McDermott, MM, Stoffers, HEJH, Knottnerus, JA, Ogren, M, Hedblad, B, Koenig, W, Meisinger, C, Cauley, JA, Franco, OH, Hunink, MGM, Hofman, A, Witteman, JC, Criqui, MH, Langer, RD, Hiatt, WR, Hamman, RF & Ankle Brachial Index Collaboration, T 2014, 'Development and validation of an ankle brachial index risk model for the prediction of cardiovascular events', European Journal of Preventive Cardiology, vol. 21, no. 3, pp. 310-320. https://doi.org/10.1177/2047487313516564

Development and validation of an ankle brachial index risk model for the prediction of cardiovascular events. / Fowkes, F.G.R.; Murray, G.D.; Butcher, I.; Folsom, A.R.; Hirsch, A.T.; Couper, D.J.; DeBacker, G.; Kornitzer, M.; Newman, A.B.; Sutton-Tyrrell, K.C.; Cushman, M.; Lee, A.J.; Price, J.F.; D'Agostino Sr, R.B.; Murabito, J.M.; Norman, P.E.; Masaki, K.H.; Bouter, L.M.; Heine, R.J.; Stehouwer, C.D.A.; McDermott, M.M.; Stoffers, H.E.J.H.; Knottnerus, J.A.; Ogren, M.; Hedblad, B.; Koenig, W.; Meisinger, C.; Cauley, J.A.; Franco, O.H.; Hunink, M.G.M.; Hofman, A.; Witteman, J.C.; Criqui, M.H.; Langer, R.D.; Hiatt, W.R.; Hamman, R.F.; Ankle Brachial Index Collaboration, the.

In: European Journal of Preventive Cardiology, Vol. 21, No. 3, 03.2014, p. 310-320.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Development and validation of an ankle brachial index risk model for the prediction of cardiovascular events

AU - Fowkes, F.G.R.

AU - Murray, G.D.

AU - Butcher, I.

AU - Folsom, A.R.

AU - Hirsch, A.T.

AU - Couper, D.J.

AU - DeBacker, G.

AU - Kornitzer, M.

AU - Newman, A.B.

AU - Sutton-Tyrrell, K.C.

AU - Cushman, M.

AU - Lee, A.J.

AU - Price, J.F.

AU - D'Agostino Sr, R.B.

AU - Murabito, J.M.

AU - Norman, P.E.

AU - Masaki, K.H.

AU - Bouter, L.M.

AU - Heine, R.J.

AU - Stehouwer, C.D.A.

AU - McDermott, M.M.

AU - Stoffers, H.E.J.H.

AU - Knottnerus, J.A.

AU - Ogren, M.

AU - Hedblad, B.

AU - Koenig, W.

AU - Meisinger, C.

AU - Cauley, J.A.

AU - Franco, O.H.

AU - Hunink, M.G.M.

AU - Hofman, A.

AU - Witteman, J.C.

AU - Criqui, M.H.

AU - Langer, R.D.

AU - Hiatt, W.R.

AU - Hamman, R.F.

AU - Ankle Brachial Index Collaboration, the

PY - 2014/3

Y1 - 2014/3

N2 - The ankle brachial index (ABI) is related to risk of cardiovascular events independent of the Framingham risk score (FRS). The aim of this study was to develop and evaluate a risk model for cardiovascular events incorporating the ABI and FRS.An analysis of participant data from 18 cohorts in which 24,375 men and 20,377 women free of coronary heart disease had ABI measured and were followed up for events.Subjects were divided into a development and internal validation dataset and an external validation dataset. Two models, comprising FRS and FRS?+?ABI, were fitted for the primary outcome of major coronary events.In predicting events in the external validation dataset, C-index for the FRS was 0.672 (95% CI 0.599 to 0.737) in men and 0.578 (95% CI 0.492 to 0.661) in women. The FRS?+?ABI led to a small increase in C-index in men to 0.685 (95% CI 0.612 to 0.749) and large increase in women to 0.690 (95% CI 0.605 to 0.764) with net reclassification improvement (NRI) of 4.3% (95% CI 0.0 to 7.6%, p?=?0.050) and 9.6% (95% CI 6.1 to 16.4%, p?<?0.001), respectively. Restricting the FRS?+?ABI model to those with FRS intermediate 10-year risk of 10 to 19% resulted in higher NRI of 15.9% (95% CI 6.1 to 20.6%, p?<?0.001) in men and 23.3% (95% CI 13.8 to 62.5%, p?=?0.002) in women. However, incorporating ABI in an improved newly fitted risk factor model had a nonsignificant effect: NRI 2.0% (95% CI 2.3 to 4.2%, p?=?0.567) in men and 1.1% (95% CI 1.9 to 4.0%, p?=?0.483) in women.An ABI risk model may improve prediction especially in individuals at intermediate risk and when performance of the base risk factor model is modest.

AB - The ankle brachial index (ABI) is related to risk of cardiovascular events independent of the Framingham risk score (FRS). The aim of this study was to develop and evaluate a risk model for cardiovascular events incorporating the ABI and FRS.An analysis of participant data from 18 cohorts in which 24,375 men and 20,377 women free of coronary heart disease had ABI measured and were followed up for events.Subjects were divided into a development and internal validation dataset and an external validation dataset. Two models, comprising FRS and FRS?+?ABI, were fitted for the primary outcome of major coronary events.In predicting events in the external validation dataset, C-index for the FRS was 0.672 (95% CI 0.599 to 0.737) in men and 0.578 (95% CI 0.492 to 0.661) in women. The FRS?+?ABI led to a small increase in C-index in men to 0.685 (95% CI 0.612 to 0.749) and large increase in women to 0.690 (95% CI 0.605 to 0.764) with net reclassification improvement (NRI) of 4.3% (95% CI 0.0 to 7.6%, p?=?0.050) and 9.6% (95% CI 6.1 to 16.4%, p?<?0.001), respectively. Restricting the FRS?+?ABI model to those with FRS intermediate 10-year risk of 10 to 19% resulted in higher NRI of 15.9% (95% CI 6.1 to 20.6%, p?<?0.001) in men and 23.3% (95% CI 13.8 to 62.5%, p?=?0.002) in women. However, incorporating ABI in an improved newly fitted risk factor model had a nonsignificant effect: NRI 2.0% (95% CI 2.3 to 4.2%, p?=?0.567) in men and 1.1% (95% CI 1.9 to 4.0%, p?=?0.483) in women.An ABI risk model may improve prediction especially in individuals at intermediate risk and when performance of the base risk factor model is modest.

KW - PERIPHERAL ARTERIAL-DISEASE

KW - CORONARY-HEART-DISEASE

KW - LOWER-EXTREMITY

KW - FOLLOW-UP

KW - TASK-FORCE

KW - PRACTICE GUIDELINES

KW - PRESSURE INDEX

KW - OLDER-ADULTS

KW - PRIMARY-CARE

KW - ALL-CAUSE

U2 - 10.1177/2047487313516564

DO - 10.1177/2047487313516564

M3 - Article

VL - 21

SP - 310

EP - 320

JO - European Journal of Preventive Cardiology

JF - European Journal of Preventive Cardiology

SN - 2047-4873

IS - 3

ER -